Targeted screening may be the best and most cost effective way for detecting one of the world’s most common causes of irreversible blindness, say researchers.
Glaucoma is the name of a group of eye diseases that affects vision. If left untreated, it can eventually cause blindness.
A UK research team led from the University of Aberdeen were asked to compare the clinical and cost effectiveness of current screening for open angle glaucoma (OAG) - the most common form of the disease - against two new ideas for screening which are not currently in practice.
The research was conducted ahead of new legislation introduced in 2006 by the then Scottish Executive which has resulted in everyone in Scotland being eligible for free eye examinations.
The researchers – who were asked to carry out the research by the National Institute for Health Research's Health Technology Assessment (NIHR HTA) programme - developed models for two new potential screening strategies.
One involved a technician carrying out two tests on people considered to be at risk of OAG. Those testing positive for OAG would then be referred for specialised optometrist assessment.
The second potential strategy - which cost more - involved at risk patients being invited to see a glaucoma optometrist straight away.
In their research published today by the NIHR Health Technology Assessment programme - which is expected to inform the UK National Screening Committee - the team report that screening the general population, based on age criteria alone, for OAG would not be cost-effective and does not meet all the National Screening Committee's criteria for a screening programme.
They found both potential strategies more effective than current practice although both were more costly.
And of the two screening strategies examined, the technician strategy was the more cost effective option.
The researchers conclude that targeted screening of high-risk groups may be effective and cost-effective, although measures to systematically identify those at risk and quality assure the programme would be required.
Dr Jennifer Burr, Clinical Epidemiologist at the University of Aberdeen's Health Services Research Unit, led the research. She said: "Many cases of Open Angle Glaucoma are undetected and there are a number of people who are more at risk of the condition than others, such as those with a first-degree relative with glaucoma, or those of black ethnicity.
"Our research suggests that a targeted screening system could be considered, although further research is required.
"In addition, glaucoma detection can be improved by enhancing the performance of current testing, and adding a technology-based initial assessment before referral to a specialist seems the more cost-effective option. We hope that the findings of our research will help to inform any future organisational changes in community eye care services."
The report is published in Health Technology Assessment Journal Series Vol.11.41. To view and download the full report visit: http://www.hta.ac.uk/project/1446.asp